In Reply.—Drs McNagny and Ahluwalia suggest that OTC use of the transdermal nicotine patch might increase its costeffectiveness; any loss in effectiveness would be more than offset by transferring costs to the purchaser of the patch. This is a disingenuous argument. Simply shifting costs does not improve cost-effectiveness. Furthermore, the cost of the patch is most often borne by the user, not a third-party payer, so OTC approval will not result in consumer savings unless the OTC patch is priced lower than the prescription patch.We agree that there is limited evidence regarding the effectiveness of the patch in the absence of physician advice. However, the California Tobacco Survey1 is the only study that we could identify that compares rates of quitting with the patch in the absence of advice with rates of quitting without the patch. The study by Orleans et al2 cited by McNagny and Ahluwalia only